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Background: Innovative analytic approaches to drug studies are needed to understand better the co-use of opioids with non-opioids among people using illicit drugs. One approach is the Bayesian kernel machine regression (BKMR), widely applied in environmental epidemiology to study exposure mixtures but has received far less attention in substance use research.Objective: To describe the utility of the BKMR approach to study the effects of drug substance mixtures on health outcomes.Methods: We simulated data for 200 individuals. Using the Vale and Maurelli method, we simulated multivariate non-normal drug exposure data: xylazine (mean = 300 ng/mL, SD = 100 ng/mL), fentanyl (mean = 200 ng/mL, SD = 71 ng/mL), benzodiazepine (mean = 300 ng/mL, SD = 55 ng/mL), and nitazene (mean = 200 ng/mL, SD = 141 ng/mL) concentrations. We performed 10,000 MCMC sampling iterations with three Markov chains. Model diagnostics included trace plots, r-hat values, and effective sample sizes. We also provided visual relationships of the univariate and bivariate exposure-response and the overall mixture effect.Results: Higher levels of fentanyl and nitazene concentrations were associated with higher levels of the simulated health outcome, controlling for age. Trace plots, r-hat values, and effective sample size statistics demonstrated BKMR stability across multiple Markov chains.Conclusions: Our understanding of drug mixtures tends to be limited to studies of single-drug models. BKMR offers an innovative way to discern which substances pose a greater health risk than other substances and can be applied to assess univariate, bivariate, and cumulative drug effects on health outcomes.
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Self-medication, the unsupervised use of drugs, is a common global behavior with potential adverse health outcomes. This study explores the prevalence and patterns of self-medication in Saudi Arabia, focusing on factors such as drug availability, economic constraints, and public trust in healthcare systems. Particular emphasis is placed on self-medication with antibiotics and prescription drugs due to their significant public health risks. Our comprehensive, quantitative, cross-sectional study surveyed 1,671 individuals across Saudi Arabia's diverse regions. We found that 75.5% of respondents engaged in self-medication, primarily on an occasional basis. While 59.8% of participants perceived self-medication as safe, 17.5% reported experiencing adverse effects. Respondents strongly advocated for increased regulatory measures (87.7%) and a pressing need for enhanced public education (92.6%) to address the associated risks. The study highlights the widespread practice of self-medication in Saudi Arabia, influenced by various factors, and underscores the need for targeted health policies and educational campaigns to mitigate these risks.
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BACKGROUND: Adolescent drug use has long term health consequences, like substance use disorders and psychiatric illnesses. Proximal health risks, especially for overdose, are amplified when multiple substances are combined. Existing literature on polysubstance use among adolescents has largely focused on alcohol, tobacco, and marijuana, but has largely excluded other drugs like opioids. Understanding how adolescents combine illicit drugs is essential for intervening to prevent poor health outcomes. METHODS: We aimed to explore patterns of lifetime polysubstance use among adolescents in Baltimore City. We used data on 9th-12th graders recruited to participate in the 2017 local Baltimore Youth Risk Behavior Survey who reported any lifetime drug use (n = 387; 60 % female, 77 % non-Hispanic Black). We then conducted a latent class analysis using 10 indicators of lifetime drug and alcohol use. After selecting the class model, we tested for associations between the class profiles and race, sex, school grade, and lifetime injection drug use. RESULTS: We identified three profiles of lifetime polysubstance use in our sample: alcohol and marijuana (68.6 % of sample), polysubstance (22.0 %), and alcohol/pain medication/inhalant use (9.4 %). Members of the polysubstance use class were more likely to be male and to report injection drug use. CONCLUSIONS: Understanding broader patterns of drug use beyond alcohol, tobacco and marijuana among adolescents is a crucial step towards preventing adverse drug and health-related outcomes later in life. More research is needed to characterize the full health impact of youth polysubstance use patterns and related risk behaviors like injection drug use.
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Conducta del Adolescente/psicología , Análisis de Clases Latentes , Instituciones Académicas/tendencias , Estudiantes/psicología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adolescente , Baltimore/epidemiología , Bases de Datos Factuales/tendencias , Femenino , Humanos , Drogas Ilícitas , Masculino , Asunción de Riesgos , Uso de Tabaco/epidemiología , Uso de Tabaco/psicología , Uso de Tabaco/tendencias , Consumo de Alcohol en Menores/psicología , Consumo de Alcohol en Menores/tendenciasRESUMEN
This study identifies patterns of simultaneous polysubstance use (SPU) in partygoers, their associated characteristics, and their differences in terms of acute effects experienced. We used a web-based survey with 1345 partygoers who reported using at least one substance during the past year, collecting information on drug use and drug-related acute effects experienced at the last party attended. Latent class analysis identified three SPU profiles according to the use of nine substances: low polysubstance use (67.7%), moderate polysubstance use/hallucinogens (11.6%), and extensive polysubstance use/stimulants (20.7%). These profiles differed in their sociodemographic characteristics and were associated with different odds of experiencing adverse drug-related effects. Compared with participants with a profile of low polysubstance use or moderate polysubstance use/hallucinogens, those in the extensive polysubstance use/stimulants group were at higher odds of experiencing memory impairment, tachycardia, and bad mood after drug use. The only differences between the low polysubstance use and moderate polysubstance use/hallucinogens groups were in terms of hangover and headache experiences, which were less likely in the latter group (who consume less alcohol). Knowledge regarding the acute adverse drug-related effects experienced by partygoers who use multiple drugs can help to develop interventions for reducing drug-related risks in this population.
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Estimulantes del Sistema Nervioso Central , Alucinógenos , Drogas Ilícitas , Trastornos Relacionados con Sustancias , Humanos , Drogas Ilícitas/efectos adversos , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y CuestionariosRESUMEN
Purpose: To describe drug-use patterns in patients with multiple sclerosis (MS) using disease-modifying drugs (DMDs) and to estimate the incidence of severe adverse events (SAEs) of treatment. Methods: We conducted a cohort study within the German Pharmacoepidemiological Research Database between January 1, 2006 and December 31, 2013. MS patients on DMDs were described in terms of clinical characteristics and drug-use patterns. Next, we assessed the incidence of AEs in new users of fingolimod, natalizumab, glatiramer acetate, and IFNß1a. Results: Among approximately 11 million insured members of German Statutory Health Insurance, the DMD-user cohort comprised 15,377 patients with MS, with a mean age of 39.6 years and 68% females. Nearly half of all DMD users had a diagnosis of depression, with prevalence ranging from 40.1% for IFNß1a to 62.3% for immunoglobulins. The overall rate of MS relapses per patient and year was 0.34 (95% CI 0.33-0.34). During an average follow-up of 1,650 days, the majority (42.4%) of MS patients were adherent to DMD treatment ("continuous single users"), followed by patients interrupting treatment (39.5%, "interrupters"). Switch of DMD treatment (11.9%) was less frequent, and only 5.6% discontinued treatment. Treatment discontinuation was most common in users of natalizumab (7.5%) and IFNß1b (7.0%). The most frequent SAE was hospitalization for depression, followed by any infectious disease and any malignancy. The incidence rate of all adverse events did not significantly differ across different DMDs. Conclusion: Treatment discontinuation with DMDs and treatment switch were rare. Causes of rather frequent DMD-treatment interruption have to be evaluated in further studies based on primary data collection. Active safety monitoring of new DMDs based on claims data requires large data sets to detect rare AEs and availability of up-to-date data.
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BACKGROUND: Little is known about drug use patterns among people living with HIV in comparison to an uninfected group in the general population. The aim of this study was to investigate the association between legal and illegal drug use and HIV infection in a nationally representative sample of adults in the United States. METHODS: Public use data files (2005-2014) from the National Survey on Drug Use and Health (NSDUH) were used. Respondents were asked whether a medical professional had ever told them that they had HIV/AIDS. Ever (lifetime), past-year, and past month use of cigarettes, alcohol, marijuana, cocaine, heroin, hallucinogens, inhalants, and nonmedical use of psychotherapeutics was assessed. Logistic regression was used to estimate adjusted odds ratios (aOR) of the relationship between drug use and HIV infection, adjusting for demographics. RESULTS: Of 377,787 respondents age 18 and older, 548 (0.19%) were categorized as HIV-infected. Ever use of cigarettes, tobacco, marijuana, cocaine, heroin, hallucinogens, inhalants, and psychotherapeutics was higher in HIV-infected individuals compared to HIV-uninfected individuals after adjustment for sex, age, race/ethnicity, education, total family income, and marital status. Past year and past month use was also higher for HIV-infected individuals for all substances aside from alcohol. CONCLUSIONS: In a nationally representative sample, there are higher levels of drug use and DSM-IV dependence among the HIV-infected population compared to the HIV-uninfected population. This is of concern because drug use and dependence can impede engagement in HIV care and adherence to antiretroviral therapy.
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Infecciones por VIH/epidemiología , Encuestas Epidemiológicas/estadística & datos numéricos , Mal Uso de Medicamentos de Venta con Receta/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Comorbilidad , Femenino , Encuestas Epidemiológicas/métodos , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Distribución por Sexo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Patient-centered care is now the goal for virtually all healthcare systems. The aim of this research was to evaluate the patient care quality in regard to drug dispensing in four hospitals in southern Ethiopia namely Wolaita Sodo University teaching and referral hospital (WSUTRH), Tercha zonal hospital (TZH), Sodo Christian hospital (SCH) and Dubo St. Mary's Catholic primary hospital (DSMCPH). METHODS: A cross sectional study was conducted by using the WHO patient care and facility indicators between September 10 and October 20, 2014. Patients who visited the outpatient departments of the four hospitals were selected by systematic random sampling method and interviewed. In total 384 patients were selected based on a rough estimate of proportion of patients visiting to the four hospitals. Facility indicators including the availability of essential drugs list (EDL), national drug formulary, standard treatment guideline (STG) and key drugs were evaluated. Descriptive statistical calculations were performed using SPSS® version 20.0 software. RESULT: The mean number of drugs was in the range between 1.9 ± 0.9 to 2.2 ± 2.0. The mean consultation time range was found to be 4.2 ± 1.6 to 4.9 ± 5.0 min whereas the mean dispensing time was ranged from 96.1 ± 52.0 to 152.3 ± 47.6 s. The overall mean number of drug prescribed for the four hospitals was 2.0 ± 1.2 and the mean percentage of medications actually dispensed in the hospitals was thus calculated to be 86.3. The mean percentage of medications clearly labeled was 45.4. Patients who knew their dosage forms accurately were 78.8. Among the four hospitals evaluated only one hospital (25 %) had at least a copy of the Ethiopian essential drug list (EDL), standard treatment guideline for hospitals and drug formulary. The mean availability of key drugs in the hospitals was found to be 65.7 %. CONCLUSION: The result of the present study indicates that the patient consulting time, medications labeling and availability of key drugs in the hospitals are inadequate. The medication labeling practice in the four hospitals is unacceptably low. These patient care indicators need a special attention for improvement.
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Medicamentos Esenciales/provisión & distribución , Atención Dirigida al Paciente/normas , Adolescente , Adulto , Anciano , Estudios Transversales , Etiquetado de Medicamentos/normas , Etiquetado de Medicamentos/estadística & datos numéricos , Prescripciones de Medicamentos/estadística & datos numéricos , Revisión de la Utilización de Medicamentos , Medicamentos Esenciales/uso terapéutico , Escolaridad , Etiopía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hospitales de Enseñanza/normas , Hospitales de Enseñanza/estadística & datos numéricos , Hospitales Universitarios/normas , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Atención al Paciente , Pautas de la Práctica en Medicina , Calidad de la Atención de Salud , Derivación y Consulta , Organización Mundial de la Salud , Adulto JovenRESUMEN
After more than 30 years of research, numerous studies have shown that injection drug use is associated with a wide range of adverse health outcomes such as drug overdoses, drug-related suicidal behaviours, comorbid psychiatric disorders, bloodborne pathogens and other infectious diseases, and traumas. This review explores new trends and prominent issues associated with injection drug use. The dynamic nature of injection drug use is underlined by examining its recent trends and changing patterns in Canada and other "high-income countries." Three research topics that could further contribute to the development of comprehensive prevention and intervention strategies aimed at people who inject drugs are also discussed: risk behaviours associated with the injection of prescription opioids, binge injection drug use, and mental health problems as determinants of injection risk behaviours.
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Abuso de Sustancias por Vía Intravenosa/epidemiología , Canadá/epidemiología , Humanos , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
We conducted a review to study antibiotic and injections use at primary care centers (PHCs) within the World Health Organization African region. This was part of a larger study on prescribing indicators at PHCs within the region. We analyzed antibiotic and injection use reported in studies published between 1993 and June 2013, which were identified through searches conducted in PubMed, Scopus, Web of science, Africa-Wide NiPAD, Africa Journals Online, Google Scholar, and International Network for Rational Use of Drugs bibliography databases. Sub-group analysis was carried out for private and public centers. Data were retrieved from 18 studies in 6 countries involving 21,283 patient encounters across 338 PHCs. The percentage of patient encounters with antibiotics prescribed was 51.5% (IQR 41.1-63.3%). The percentage of patient encounters which resulted in the prescription of an injection was 36.8% (IQR 20.7-57.6%). Injection use rate at private facilities was 38% (IQR 19.1-42.7) while that of the public was 32.3% (IQR 20.6-57.6). Rate of antibiotic prescribing at public centers was 49.7% (IQR 51.1-75.7) and that of private facilities 57.6 (IQR 39.0-69.5). The percentage use of injections and antibiotics is high in Africa. The excessive use of antibiotics and injections are particularly more problematic in private than public facilities. Further research is needed to understand fully the underlying factors for the observed patterns and ways of improving medicines use.
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BACKGROUND: Non-vitamin K oral anticoagulants (NOACs) became available in the Netherlands in 2008, providing another antithrombotic treatment besides vitamin K antagonists (VKAs) and antiplatelet agents (APAs). OBJECTIVE: To describe the patterns of antithrombotic drug use between 2008 and 2013 by examination of dispensing data form community pharmacies in the Netherlands; to determine the concomitant use of NOACs with VKAs and APAs and switching between the drug classes; and to compare adherence to NOACs with adherence to APAs. SETTING: An observational retrospective study was conducted using routinely collected dispensing data from Dutch community pharmacies. METHODS: For each calendar year, the numbers of NOAC, VKA, and APA users were calculated. Adherence was determined for NOACs and APAs by the percentage of days covered by medication (PDC). Information on the prescribed daily dose of VKAs was unavailable. MAIN OUTCOME MEASURES: Comparison of age, sex, and co-medications of users of the three drug classes; concomitant use of different antithrombotic drug classes and switching between these in each year; and mean PDC and percentages of all users with a PDC above 80 %. RESULTS: NOAC use increased during the study period to 29,687 users in 2013. In that year there were 484,024 VKA users and 1313,032 APA users. Compared with users of VKAs, NOAC users were slightly younger and more frequently used antiarrhythmic drugs and beta blockers as co-medications. Substantial numbers of patients were dispensed potentially harmful combinations in 2013: 820 subjects were dispensed NOACs together with VKAs, and 684 subjects were dispensed NOACs, VKAs, and APAs concomitantly. Mean adherence to NOACs was 84.2 % compared with 87.3 % to APA. One in four NOAC users had a PDC lower than 80 % compared with one in five APA users. CONCLUSION: Our findings show increasing use of NOACs by outpatients. The number of patients taking potentially harmful combinations of antithrombotic drugs was substantial. Adherence to NOACs in daily practice may be suboptimal to prevent thrombotic events.
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Anticoagulantes/administración & dosificación , Utilización de Medicamentos/tendencias , Fibrinolíticos/administración & dosificación , Cumplimiento de la Medicación/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Antitrombinas/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Polifarmacia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Vitamina KRESUMEN
From July 2011, a one-year study based on ethnographic methodology was carried out in "crack houses" in the neighborhood of Hochelaga-Maisonneuve in Montréal, Canada. The study aimed to explore the operational style of a specific indoor drug use setting and its impact on users' risky sexual and drug use behaviors in a context of drug market change. A thematic analysis of observational and interview notes was conducted. This study stresses the importance to examine the role of environmental factors in relation to crack smoking's health-related risks and to complement individual-based interventions with structural strategies. The study's limitations are noted.
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Trastornos Relacionados con Cocaína/psicología , Cocaína Crack , Consumidores de Drogas/psicología , Asunción de Riesgos , Conducta Sexual/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario , Características de la Residencia , Trabajadores SexualesRESUMEN
BACKGROUND: The present study aimed to distinguish cannabis consumption patterns among adolescents and to relate these to life satisfaction, academic achievement, and the use of other psychoactive substances. METHODS: This study used a prospective design. Cannabis use was measured 14 times over the course of 10 years. Participants were 318 adolescents aged 14 to 15 at the beginning of the study. RESULTS: Growth mixture modeling identified 2 latent classes. Class 1 was defined by phases of high-frequency cannabis use, and Class 2 was defined by low-frequency use or nonuse. Class 1 reported decreased satisfaction with life and one's own academic and professional achievement at the age of 24 as well as higher use of tobacco and illicit substances. CONCLUSIONS: High-frequency use of cannabis predicts a decreased satisfaction with life and one's own academic and professional achievement as well as an increased use of other substances.