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PURPOSE: The prevalence of past-year prescription opioid use (POU), nonmedical POU (NMPOU), and POU disorder (POUD) and their correlates were examined in a national sample of American adolescents (N = 41,579). METHODS: This study used data from the public-use files of the 2015, 2016, and 2017 National Surveys on Drug Use and Health, which captured substance use and mental health problems among noninstitutionalized individuals. Prevalence and specific types of prescription opioids and other substances used and misused in the past year were examined among adolescents. Logistic regression analyses were conducted to determine correlates (demographics, other substances used, past-year major depressive episode, school enrollment, two-parent household, number of lifetime medical conditions, and survey year) of POU, NMPOU, and POUD. RESULTS: Multiple substance use was common within the past year. The most frequently used prescription opioids were hydrocodone, codeine, oxycodone, and other opioids among adolescents. Cannabis use disorder and alcohol use disorder were comparatively prevalent among opioid misusers. Several correlates (demographics, other substances used, lifetime medical conditions, major depressive episode, and survey year) of POU, NMPOU, and POUD were found. CONCLUSIONS: In this national sample, multiple substance use was common among adolescents with past-year POU and NMPOU. Clinical screening for opioid use problems, assessment, and treatment expansion for POUD can focus on persons with substance use, mental health, and/or behavioral problems. Longitudinal studies are needed to better elucidate temporal associations between POU and NMPOU/POUD among adolescents, and more prevention and treatment research on rural residents and minority groups is needed.
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Trastorno Depresivo Mayor , Trastornos Relacionados con Opioides , Mal Uso de Medicamentos de Venta con Receta , Adolescente , Analgésicos Opioides/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Encuestas Epidemiológicas , Humanos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiología , Prescripciones , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
Background: This commentary considers the potential return of cocaine and the need for intervention and treatment responses. Objectives: To show historical and contemporaneous epidemiological data on indicators of the expected increase in cocaine use. Methods: Data on increases in acreage of cocaine cultivation are presented, along with increases in treatment admissions, toxicological laboratory identifications of cocaine, poison center episodes, and overdose deaths. Characteristics of those entering treatment for problems with cocaine now are compared to the characteristics of those in treatment 23 year ago. Conclusions: There is a need to target prevention and intervention programs based on characteristics of users, and given the lack of FDA-approved medication-assisted treatment for cocaine, attention should be shifted to this epidemic before it reaches the severity as seen om the 1990s.
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Trastornos Relacionados con Cocaína/epidemiología , Cocaína/provisión & distribución , Sobredosis de Droga/mortalidad , Humanos , Texas/epidemiologíaRESUMEN
This article describes the characteristics of individuals who used synthetic cannabinoids and the changes in the user population over time. Data sources include treatment admissions with a primary problem with synthetic cannabinoids reported to the Texas treatment dataset, synthetic cannabinoid exposures reported to the Texas Poison Center Network, and items identified in the National Forensic Laboratory Information System in 2009-2016. Statistically significant trends were identified for race/ethnicity, gender, age, education level, employment status, homelessness, criminal justice problems, use of other substances, lag time between first use and time to treatment, exposure site, chronicity, reason for exposure, and the most common types of cannabinoids. Comparisons were made between the years and the variables in the datasets. Findings suggest that the characteristics of synthetic cannabinoid users and the varieties of these drugs in Texas have changed over time. Data to link individual cases with the changing results of toxicological analysis are needed, as well as targeted prevention and treatment efforts for an aging population who may be at risk of homelessness and also have co-morbid substance use and psychiatric problems.
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Cannabinoides/administración & dosificación , Personas con Mala Vivienda/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Factores de Edad , Cannabinoides/química , Cannabinoides/envenenamiento , Femenino , Humanos , Masculino , Centros de Control de Intoxicaciones/estadística & datos numéricos , Factores Sexuales , Trastornos Relacionados con Sustancias/complicaciones , Texas/epidemiología , Adulto JovenRESUMEN
AIMS: To estimate the prevalence of tobacco, alcohol and drug use in Iraq using data from the Iraqi National Household Survey of Alcohol and Drug Use (INHSAD). DESIGN: A cross-sectional survey was conducted using a multi-stage cluster sampling method. Trained surveyors conducted face-to-face household interviews. SETTING: Iraq, from April 2014 to December 2014. PARTICIPANTS: A total of 3200 adult, non-institutionalized Iraqi citizens residing across all 18 governorates of Iraq. MEASUREMENTS: We estimated weighted prevalence and 95% confidence intervals (CIs) for life-time, past-year and past-month use of a variety of substances (tobacco, alcohol, prescription drugs and illicit drugs). For each substance, we also estimated whether individuals knew people who currently use the substance. FINDINGS: Self-reported past-month tobacco use was 23.2% (95% CI = 21.40, 25.19). Past-month alcohol use was 3.2% (95% CI = 2.58, 3.93). Women reported significantly lower prevalence for both tobacco and alcohol use compared with men (P-value < 0.01 for both). Only 1.4% (95% CI = 0.67, 3.02) reported past-month non-medical use of any prescription drugs. None of the women reported using any illicit drugs, and only 0.2% (95% CI = 0.07, 0.49) of men reported using any illicit drugs in the past month. Approximately 90.5% (95% CI = 88.58, 92.11) knew someone who uses tobacco, 42.4% (95% CI = 39.53, 45.24) knew someone who drinks alcohol, 27.9% (95% CI = 25.53, 30.45) knew someone who uses medication outside a doctor's instructions and 9.2% (95% CI = 7.87, 10.75) knew someone who uses an illicit drug. CONCLUSIONS: Psychoactive drug use is generally low in Iraq, tobacco being highest at an estimated 23.2%. Iraqi women report significantly less substance use than Iraqi men, which may be related to cultural gender norms. Discrepancy between self-report and 'knowing someone who uses a substance' suggests under-reporting in this population.
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Consumo de Bebidas Alcohólicas/epidemiología , Encuestas Epidemiológicas/estadística & datos numéricos , Autoinforme , Trastornos Relacionados con Sustancias/epidemiología , Uso de Tabaco/epidemiología , Adolescente , Adulto , Análisis por Conglomerados , Estudios Transversales , Femenino , Humanos , Drogas Ilícitas , Entrevistas como Asunto , Irak/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Distribución por Sexo , Adulto JovenRESUMEN
OBJECTIVE: Despite successes in the 1980s and early 1990s, progress in reducing impaired driving fatalities in the United States has stagnated in recent years. Since 1997, the percentage of drivers involved in fatal crashes with illegal blood alcohol concentration (BAC) levels has remained at approximately 20 to 22%. Many experts believe that public complacency, competing social and public health issues, and the lack of political fortitude have all contributed to this stagnation. The number of alcohol-related crashes, injuries, and fatalities is still unacceptable, and most are preventable. The public needs to be aware that the problem presented by drinking drivers has not been solved. Political leaders need guidance on which measures will affect the problem, and stakeholders need to be motivated once again to implement effective strategies. METHODS: The National Academy of Sciences (NAS) Transportation Research Board (TRB), Alcohol, Other Drugs, and Transportation Committee (ANB50) sponsored a workshop held at the NAS facility in Woods Hole, Massachusetts, on August 24-25, 2015, to discuss the lack of progress in reducing impaired driving and to make recommendations for future progress. A total of 26 experts in research and policy related to alcohol-impaired driving participated in the workshop. The workshop began by examining the static situation in the rate of alcohol-impaired driving fatal crashes to determine what factors may be inhibiting further progress. The workshop then discussed 8 effective strategies that have not been fully implemented in the United States. Workshop participants (16 of the 26) rated their top 3 strategies. RESULTS: 3 strategies received the most support: 1. Impose administrative sanctions for drivers with BACs = 0.05 to 0.08 g/dL. 2. Require alcohol ignition interlocks for all alcohol-impaired driving offenders. 3. Increase the frequency of sobriety checkpoints, including enacting legislation to allow them in the 11 states that currently prohibit them. 5 other important strategies included the following: (1) increase alcohol taxes to raise the price and reduce alcohol consumption; (2) reengage the public and raise the priority of impaired driving; (3) lower the illegal per se BAC limit to 0.05 for a criminal offense; (4) develop and implement in-vehicle alcohol detection systems; and (5) expand the use of screening and brief interventions in medical facilities. CONCLUSIONS: Each of these strategies is proven to be effective, yet all are substantially underutilized. Each is used in some jurisdictions in the United States or Canada, but none is used extensively. Any one of the 3 strategies implemented on a widespread basis would decrease impaired driving crashes, injuries, and fatalities. Based on the research, all 3 together would have a substantial impact on the problem.
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Accidentes de Tránsito/mortalidad , Conducir bajo la Influencia/prevención & control , Accidentes de Tránsito/estadística & datos numéricos , Intoxicación Alcohólica/diagnóstico , Conducción de Automóvil/legislación & jurisprudencia , Conducir bajo la Influencia/legislación & jurisprudencia , Etanol/sangre , Etanol/economía , Humanos , Aplicación de la Ley/métodos , Vehículos a Motor/normas , Políticas , Detección de Abuso de Sustancias/instrumentación , Impuestos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: This study presents information on the status and impact of medical and legalized marijuana, and the latest data on attitudes and prevalence of use since implementation of these laws. Recent reports from epidemiologists in Denver and Seattle are summarized to give the readers a sense of the changes as these laws have taken effect in their communities. METHODS: The status of these laws is reviewed and the results of surveys taken before and after the laws were enacted are presented, along with data on changing potency and driving under the influence of marijuana. SUMMARY: Prevalence of use by youths has not increased, but their negative attitudes towards the risk of using marijuana have decreased, and use by adults has increased. Potency continues to increase, as has the proportion of drivers testing positive for use of the drug. Data from Denver show increases in hospital admissions, emergency department visits, and calls to poison centers, with decreasing arrests and admissions to substance abuse treatment programs. Data from the Seattle area show similar decreases in treatment admissions and police involvement, but also increased prevalence of more frequent use. CONCLUSIONS: Current data suggest that increases in marijuana use preceded legalization in 2012. Treatment admissions were declining before these laws, but some indicators of morbidity seem to be increasing subsequent to legalization, with modest increases in poison center calls in both states and increases in acute medical visits in Denver. Data are needed to understand the relationship between the patterns and amounts of use in terms of consequences, and data on the health conditions of those receiving medical marijuana and the impact of higher potency.
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Cannabis , Legislación de Medicamentos , Marihuana Medicinal , HumanosRESUMEN
BACKGROUND: The U.S.-Mexico border displays elevated rates of hazardous alcohol and drug use. Whether the co-occurrence of alcohol and drug use and disorders is also high in the border area is unknown. METHODS: Data are from the U.S.-Mexico Study on Alcohol and Related Conditions, a cross-sectional survey of randomly selected respondents interviewed from 2011 to 2013. Participants included 1,690 Mexican Americans from Texas (572 in an off-border city and 1,118 from 3 border cities) and 1,293 Mexicans from Nuevo Leon and Tamaulipas (415 in an off-border city and 878 from 3 Mexican cities bordering Texas) who reported drinking in the last 12 months. Participants were interviewed regarding the prevalence of and risk factors for: (i) co-occurring hazardous alcohol use (5+/4+ at least monthly) and drug use (medical and illicit) and (ii) co-occurring presence of a DSM-5 alcohol use disorder (AUD) and 2 symptoms (hazardous use and quit/control) of drug use disorder (DUD symptoms). RESULTS: Co-occurring hazardous alcohol and drug use was more common in the U.S. border cities (14.7%) than off-border (7.2%), but similar for Mexican border (1.2%) and off-border (1.4%) cities. Co-occurrence of AUD and DUD symptoms was likewise more common at the U.S. border (6.8%) than off-border (3.3%), as well as at the Mexican border (1.3%), compared to off-border (0.6%), but not statistically significant for Mexico. In models adjusting for demographics, mobility factors and exposure to the U.S. culture, border residence in both countries related to a nearly twofold increase in prevalence ratios (PRs) of co-occurring AUD and DUD symptoms (PR = 1.97, 95% CI = 1.36 to 2.85). CONCLUSIONS: Increased rates of co-occurring AUDs and DUDs suggest an added negative impact on already difficult conditions of the border population.
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Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Comorbilidad , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Americanos Mexicanos/estadística & datos numéricos , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Texas/epidemiología , Adulto JovenRESUMEN
Clinical and cultural characteristics of Hispanic adolescent heroin users are not well described. The current exploratory study was conducted to describe a sample of in-treatment Hispanic adolescents with opioid dependence, specifically, cheese heroin. Mexican and Mexican American adolescents with heroin dependence (N = 72) in three treatment programs were interviewed and completed self-report measures. Participants reported, on average, first using cheese heroin at age 13.5 years and daily use at age 14.2 years. The majority (74%) reported a previous overdose. Adolescents being raised by caregivers other than both biological parents, who used drugs with relatives, and whose immediate family members have documentation to be in the United States fared worse on several indicators of drug use severity and other risky behaviors. The self-reported brief time period from first use to daily use strongly suggests the need for early prevention efforts. Additional research is needed to add to these preliminary results and inform prevention efforts.
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Sobredosis de Droga/epidemiología , Dependencia de Heroína/rehabilitación , Americanos Mexicanos/estadística & datos numéricos , Centros de Tratamiento de Abuso de Sustancias , Adolescente , Estudios Transversales , Sobredosis de Droga/etnología , Familia , Femenino , Dependencia de Heroína/etnología , Humanos , Masculino , México/etnología , Estados UnidosRESUMEN
The quality and quantity of illicit methamphetamine has recently increased due to introduction of a new precursor, 1-phenyl-2-propanone (P2P). This paper updates the problems associated with methamphetamine use. Methamphetamine-using clients (N = 222) entering a Texas program participated in computer-assisted interviews in 2010 and 2011 about routes of administration, other drugs used, severity of dependence, mental and physical health, perceived risks and benefits of use, family history, and abuse and neglect experienced as children and adults. Special needs of this population include therapies for trauma, gender-focused counseling, safe housing, and prevention messages to discourage use of the drug.
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Trastornos Relacionados con Anfetaminas , Consumidores de Drogas/psicología , Necesidades y Demandas de Servicios de Salud , Metanfetamina , Adulto , Trastornos Relacionados con Anfetaminas/terapia , Femenino , Humanos , Masculino , Metanfetamina/administración & dosificación , Investigación Cualitativa , Encuestas y Cuestionarios , Texas , Interfaz Usuario-ComputadorRESUMEN
INTRODUCTION: New synthetic drugs are appearing as old hallucinogen psychedelic drugs are reappearing. This article combines the findings from a variety of datasets to characterize the users in terms of gender, age, drug use patterns, and adverse results, as well as provide an overview of the changes in formulations of these drugs and the impact of legal controls. Methods. Data from Monitoring the Future and the National Survey on Drug Use and Health are analyzed, along with the national DAWN emergency room admissions, Texas poison control center cases, and Texas treatment data, along with national forensic laboratory results. Results. Users of the synthetic cannabinoids, synthetic cathinones, phenethylamines, tryptamines, LSD, MDMA, and mushrooms tended to be young and male. They differed in terms of race and ethnicity. The effects of the drugs differed in terms of emergency room outcomes and poison center reports, and the treatment data showed they were similar in terms of education level, employment, and legal problems. Conclusion. Combining the different data sources provided a first picture of the characteristics of these users and their needs. Creditable descriptions on the risks of these drugs should be disseminated. Intervention programs should be targeted to these young users and new neuropsychobiological deficits from some of these drugs should be monitored. Because of the ever-changing chemical combinations to stay legal and the need for information on content and dosage, a more effective approach may be needed basing control on the effects of the substances rather than their changing chemical composition.
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Recolección de Datos/métodos , Psicotrópicos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Femenino , Humanos , Masculino , Centros de Control de Intoxicaciones/tendencias , Texas/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Deaths involving prescription and illicit opioids are on the rise, which is an issue of increasing concern to health care professionals, policymakers, and the public. However, because medical examiners, coroners, and other practitioners do not use uniform standards and case definitions in classifying such drug-related deaths, the incidence and prevalence data are challenging to analyze and difficult to interpret, and thus form a poor basis for crafting effective responses. To address this situation, the Substance Abuse and Mental Health Services Administration convened a Consensus Panel and charged it with devising uniform standards and case definitions that can assist medical examiners, coroners, public health officials, and others in consistently distinguishing between deaths that were caused by a certain opioids and deaths in which such a drug was detected but was not a major cause of or contributor to the death. The consensus statement presented here incorporates the panel's recommendations in four key areas.
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Causas de Muerte , Certificado de Defunción , Toxicología Forense/normas , Trastornos Relacionados con Opioides/mortalidad , Intoxicación/mortalidad , United States Substance Abuse and Mental Health Services Administration , Consenso , Consensus Development Conferences, NIH as Topic , Documentación/normas , Toxicología Forense/métodos , Guías como Asunto , Humanos , Incidencia , Trastornos Relacionados con Opioides/clasificación , Intoxicación/clasificación , Prevalencia , Literatura de Revisión como Asunto , Terminología como Asunto , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: This study examines whether Mexico's controls on ephedrine and pseudoephedrine, the two precursor chemicals that yield the most potent form of methamphetamine, d-methamphetamine, impacted the prevalence/availability of less potent types of methamphetamine in the United States-types associated with the alternative precursor chemical P2P. METHOD: Using ARIMA-intervention time series analysis of monthly drug exhibits (a prevalence/availability indicator) from the System to Retrieve Information from Drug Evidence (STRIDE), we tested whether Mexico's controls, which began in 2005, were associated with growth/decline in d-methamphetamine and growth/decline in P2P-associated, less potent l-methamphetamine, racemic methamphetamine (a 50:50 ratio of d- and l-isomers), and mixed isomer methamphetamine (an unequal ratio of d- and l-isomers). Heroin, cocaine and marijuana exhibits were used for quasi-control (01/2000-04/2011). RESULTS: Mixed-isomer exhibits constituted about 4% of the methamphetamine exhibits before Mexico's controls, then rose sharply in association with them and remained elevated, constituting about 37% of methamphetamine exhibits in 2010. d-Methamphetamine exhibits dropped sharply; l-methamphetamine and racemic methamphetamine exhibits had small rises. d-Methamphetamine exhibits partially recovered in the US West, but little recovery occurred in the US Central/South. Quasi-control series were generally unaffected. CONCLUSION: The US methamphetamine market changed. Widespread emergence of less potent methamphetamine occurred in conjunction with Mexico's controls. And prevalence/availability of the most potent type of the drug, d-methamphetamine, declined, a partial recovery in the West notwithstanding. Granting that lower potency drugs typically engender less dependence and attendant problems, these findings suggest that, following Mexico's controls, the potential harm of a sizeable amount of the US methamphetamine supply decreased.
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Estimulantes del Sistema Nervioso Central/análisis , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Metanfetamina/análisis , Algoritmos , Cannabis/química , Estimulantes del Sistema Nervioso Central/química , Cocaína/análisis , Control de Medicamentos y Narcóticos/tendencias , Efedrina/química , Geografía , Heroína/análisis , Humanos , Metanfetamina/química , México , Modelos Estadísticos , Narcóticos/análisis , Seudoefedrina/química , Estereoisomerismo , Estados UnidosRESUMEN
BACKGROUND: An unexpected outbreak of "cheese" heroin, which contained diphenhydramine and usually acetaminophen, began in Dallas around 2004. Onset occurred among youths living in neighborhoods populated by first-generation Hispanic immigrants. Little was known about the problem or the social strengths and deficits of these youth, who were primarily inhalers ("snorters") but at risk of transitioning to injection. METHODS: Multiple data sources were used, including surveys, data from emergency departments, law enforcement, treatment programs, and coroner, and interviews with users and key informants. RESULTS: Among heroin users under age 20, overdose deaths peaked in 2006, the school survey responses to using "cheese" heroin peaked in 2007, and treatment admissions peaked in 2008. Hispanic youth entering treatment were less likely to be injectors and report fewer problems than their Anglo counterparts and they were more likely to live with their families and to be supported by them. Sixty percent of the Hispanic youth had been in treatment previously and only 53% completed treatment. Cocaine and/or benzodiazepines were involved in 32% of the adolescent heroin deaths. CONCLUSIONS: The timely use of multiple data sources enabled this outbreak to be quickly identified and monitored, and the Cheese Heroin Task Force used the collected data to help respond to the problem, although retention in treatment and readmissions remained problematic. Cultural problems including immigration status, language, and misunderstandings about the nature of treatment were barriers to successful treatment outcomes. Completion of treatment as an inhaler is critical to reducing the likelihood of transitioning to injection.
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Dependencia de Heroína/psicología , Heroína , Narcóticos , Acetaminofén/efectos adversos , Acetaminofén/química , Adolescente , Factores de Edad , Analgésicos no Narcóticos/efectos adversos , Analgésicos no Narcóticos/química , Animales , Interpretación Estadística de Datos , Difenhidramina/efectos adversos , Difenhidramina/química , Brotes de Enfermedades , Sobredosis de Droga , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Heroína/efectos adversos , Heroína/química , Dependencia de Heroína/complicaciones , Dependencia de Heroína/epidemiología , Hispánicos o Latinos , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Antagonistas de los Receptores Histamínicos H1/química , Humanos , Lactosa , Masculino , Narcóticos/efectos adversos , Narcóticos/química , Centros de Control de Intoxicaciones , Instituciones Académicas , Texas/epidemiología , Población Blanca , Adulto JovenRESUMEN
BACKGROUND: Driving under the influence (DUI) of drugs is increasing in the U.S., but little is known about the differences based on their patterns of use and abuse of alcohol and other drugs. METHODS: This paper uses a large dataset to study patients admitted to Texas substance abuse treatment programs with one or more past-year DUI arrests. t-Tests are used for comparisons between normally distributed continuous data and chi square for categorical data. RESULTS: First-time DUI offenders not only differ from those reporting more than one past-year DUI, but they differ among themselves in terms of demographics, treatment participation, substance use problems, and mental health disorders. Those with primary problems with methamphetamine, crack cocaine, powder cocaine, other opiates, sedatives, and heroin reported more days of problems and more daily use than those with problems with alcohol, while offenders with primary problems with cannabis were less impaired. CONCLUSIONS: The most impaired clients were less likely to be referred to treatment from the justice system, and the differences in drug and alcohol offenders show the need to tailor approaches with education and treatment programs. More attention should be given to the needs of drivers impaired through use of prescription drugs such as the opiates and sedatives, as well as female drivers, and the role of acculturation should be recognized in programs for Hispanic drivers. In addition, specific programs should be targeted to young cannabis abusers and underage offenders. All first-time DUI arrestees should be assessed for their levels of impairment.
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Intoxicación Alcohólica/psicología , Conducción de Automóvil/psicología , Trastornos Relacionados con Sustancias/psicología , Adulto , Conducción de Automóvil/legislación & jurisprudencia , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Following more than two decades of generally increasing trends in the use and abuse of methamphetamine in certain parts of the country, prevalence indicators for the drug began to decrease in the mid-2000's-but was this decrease signaling the end of the "meth problem"? This paper has compiled historical and recent data from supply and demand indicators to provide a broader context within which to consider the changes in trends over the past half decade. Data suggest supply-side accommodation to changes in precursor chemical restrictions, with prevalence indicators beginning to attenuate in the mid-2000's and then increasing again by 2009-2010. Results support the need for continuing attention to control and interdiction efforts appropriate to the changing supply context and to continuing prevention efforts and increased number of treatment programs.
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Trastornos Relacionados con Anfetaminas/epidemiología , Drogas Ilícitas , Metanfetamina/provisión & distribución , Trastornos Relacionados con Anfetaminas/historia , Control de Medicamentos y Narcóticos , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Drogas Ilícitas/historia , Masculino , Metanfetamina/historia , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION AND AIMS: Abuse of prescription analgesics in the USA is increasing. The epidemic has been driven by many factors, including marketing strategies, incorrect prescribing practices, a variety of legal and illegal drug sources, belated governmental responses and increases in the number of prescriptions written. DESIGN AND METHODS: Data sources including surveys, emergency room visits, treatment admissions, overdose deaths, toxicology laboratory findings and journal articles were examined to identify trends. RESULTS: The surveys and emergency department visits show use lowest among young teenagers and highest among older teenagers and young adults, with significant increases among those aged 55 and older. The length of time between initial use of an opioid other than heroin and admission to treatment is shortening. Mortality data and toxicology exhibits confirm the increases and show the variation in the prevalence of various drugs across the USA. DISCUSSION AND CONCLUSIONS: Abuse is increasing, with varying patterns of use by high-risk groups and different geographic preferences. Prescription drug monitoring programs are being developed in each of the US states to deter 'doctor shopping'; the Food and Drug Administration has increased authority over manufacturers; and options for proper disposal of leftover medications exist. There is increased emphasis on responsible prescribing including risk assessments, prescribing agreements, treatment plans, and training for clinicians, as well as monitoring the interactions with benzodiazepines. However, unless these efforts decrease diversion, abuse and addiction, clinicians may lose the ability to use some of these opioids for effective pain management or so many barriers will be raised that pain will go undertreated or untreated.
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Recolección de Datos/tendencias , Servicios Médicos de Urgencia/tendencias , Epidemias , Medicamentos bajo Prescripción , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicamentos bajo Prescripción/efectos adversos , Medicamentos bajo Prescripción/uso terapéutico , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/mortalidad , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: Research is beginning to provide an indication of the co-occurring substance abuse and mental health needs for the driving under the influence (DUI) population. This study aimed to examine the extent of such psychiatric problems among a large sample size of DUI offenders entering treatment in Texas. METHODS: This is a study of 36,373 past year DUI clients and 308,714 non-past year DUI clients admitted to Texas treatment programs between 2005 and 2008. Data were obtained from the State's administrative dataset. RESULTS: Analysis indicated that non-past year DUI clients were more likely to present with more severe illicit substance use problems, while past year DUI clients were more likely to have a primary problem with alcohol. Nevertheless, a cannabis use problem was also found to be significantly associated with DUI recidivism in the last year. In regards to mental health status, a major finding was that depression was the most common psychiatric condition reported by DUI clients, including those with more than one DUI offence in the past year. This cohort also reported elevated levels of Bipolar Disorder compared to the general population, and such a diagnosis was also associated with an increased likelihood of not completing treatment. Additionally, female clients were more likely to be diagnosed with mental health problems than males, as well as more likely to be placed on medications at admission and more likely to have problems with methamphetamine, cocaine, and opiates. CONCLUSIONS: DUI offenders are at an increased risk of experiencing comorbid psychiatric disorders, and thus, corresponding treatment programs need to cater for a range of mental health concerns that are likely to affect recidivism rates.
Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Intoxicación Alcohólica/epidemiología , Drogas Ilícitas , Trastornos Mentales/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alcoholismo/epidemiología , Alcoholismo/rehabilitación , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/rehabilitación , Trastorno Bipolar/epidemiología , Trastorno Bipolar/rehabilitación , Niño , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/rehabilitación , Femenino , Humanos , Masculino , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Esquizofrenia/epidemiología , Esquizofrenia/rehabilitación , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/rehabilitación , Texas , Adulto JovenRESUMEN
AIMS: Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US-Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity. DESIGN: Distances (proximity) between the US-Mexico border and locations of methamphetamine, cocaine and heroin seizures/acquisitions (n = 239,070) recorded in STRIDE (System to Retrieve Information from Drug Evidence) were calculated for the period of 1990-2004. The association of drug purity with these distances and other variables, including time and seizure/acquisition size, was examined using hierarchical multivariate linear modeling (HMLM). SETTING: Coterminous United States. FINDINGS: Methamphetamine, cocaine and heroin purity generally decreased with distance from the US-Mexico border. Heroin purity, however, after initially declining with distance, turned upwards-a U-shaped association. During 2000-04, methamphetamine purity also had a U-shaped association with distance. For each of the three drugs, temporal changes in the purity of small acquisitions (<10 g) were typically more dynamic in areas closer to the US-Mexico border. CONCLUSIONS: Geographic variance in methamphetamine, cocaine and heroin purity throughout the coterminous United States was associated with US-Mexico border proximity. The U-shaped associations between border-distance and purity for heroin and methamphetamine may be due to imports of those drugs via the eastern United States and southeast Canada, respectively. That said, areas closer to the US-Mexico border generally had relatively high illicit drug purity, as well as more dynamic change in the purity of small ('retail level') drug amounts.
Asunto(s)
Cocaína/química , Contaminación de Medicamentos/estadística & datos numéricos , Control de Medicamentos y Narcóticos/estadística & datos numéricos , Heroína/química , Metanfetamina/química , Modelos Estadísticos , Cocaína/provisión & distribución , Comercio/legislación & jurisprudencia , Comercio/estadística & datos numéricos , Interpretación Estadística de Datos , Composición de Medicamentos , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Heroína/provisión & distribución , Humanos , Almacenamiento y Recuperación de la Información , Modelos Lineales , Metanfetamina/provisión & distribución , México , Factores de Tiempo , Estados UnidosRESUMEN
AIMS: To help counter problems related to methamphetamine, Mexico has implemented interventions targeting pseudoephedrine and ephedrine, the precursor chemicals commonly used in the drug's synthesis. This study examines whether the interventions impacted methamphetamine treatment admissions-an indicator of methamphetamine consequences. DESIGN: Quasi-experiment: autoregressive integrated moving average (ARIMA)-based intervention time-series analysis. INTERVENTIONS: precursor chemical restrictions implemented beginning November 2005; major rogue precursor chemical company closed (including possibly the largest single drug-cash seizure in history) March 2007; precursor chemicals banned from Mexico (North America's first precursor ban) August 2008. SETTINGS: Mexico and Texas (1996-2008). MEASUREMENTS: Monthly treatment admissions for methamphetamine (intervention series) and cocaine, heroin and alcohol (quasi-control series). FINDINGS: The precursor restriction was associated with temporary methamphetamine admissions decreases of 12% in Mexico and 11% in Texas. The company closure was associated with decreases of 56% in Mexico and 48% in Texas; these decreases generally remained to the end of the study period. Neither intervention was associated with significant changes in the Mexico or Texas quasi-control series. The analysis of Mexico's ban was indeterminate due largely to a short post-ban series. CONCLUSIONS: This study, one of the first quasi-experimental analyses of an illicit-drug policy in Mexico, indicates that the country's precursor interventions were associated with positive impacts domestically and in one of the Unites States' most populous states--Texas. These interventions, coupled with previous US and Canadian interventions, amount to a new, relatively cohesive level of methamphetamine precursor control across North America's largest nations, raising the possibility that the impacts found here could continue for an extended period.
Asunto(s)
Trastornos Relacionados con Anfetaminas/prevención & control , Estimulantes del Sistema Nervioso Central/provisión & distribución , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Metanfetamina/provisión & distribución , Admisión del Paciente/estadística & datos numéricos , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos , Trastornos Relacionados con Anfetaminas/epidemiología , Trastornos Relacionados con Anfetaminas/rehabilitación , Estimulantes del Sistema Nervioso Central/síntesis química , Efedrina/química , Efedrina/provisión & distribución , Humanos , Metanfetamina/síntesis química , México/epidemiología , Admisión del Paciente/tendencias , Seudoefedrina/química , Seudoefedrina/provisión & distribución , Texas/epidemiología , Factores de TiempoRESUMEN
Abuse of prescription opioids is a growing problem. The number of methadone pain pills distributed now exceeds liquid methadone used in opioid treatment, and the increases in buprenorphine indicators provide evidence of the need to monitor and intervene to decrease the abuse of this drug. The need for additional and improved data to track trends is discussed, along with findings as to the characteristics of the users and combinations of drugs. Data on toxicities related to methadone or buprenorphine, particularly in combination with other prescribed drugs, are presented and clinical implications and considerations are offered. These findings underscore the need for physicians to be aware of potential toxicities and to educate their patients regarding these issues.