Are all drug addicts impulsive? Effects of antisociality and extent of multidrug use on cognitive and motor impulsivity

The purpose of this investigation was to examine the influence of antisociality and extent of multidrug use on cognitive and motor impulsivity among substance-dependent individuals (SDIs) that used primarily cocaine and/or heroin. One hundred currently abstinent male SDIs participated in the study. Extent of multidrug use and degree of antisociality, assessed with the Socialization Scale of the California Psychological Inventory (So-CPI), were used to classify participants into one of four groups: high antisocial/low multidrug use, high antisocial/high multidrug use, low antisocial/low multidrug use, and low antisocial/high multidrug use. All subjects completed the Iowa Gambling Task to assess cognitive impulsivity and the Stroop Task to measure motor impulsivity. Contrary to expectations, antisociality was associated with more advantageous performance on the Iowa Gambling Task, independent of extent of multidrug use. In contrast, greater multidrug use was associated with general psychomotor slowing on the Stroop Task. Results suggest that a subclinical form of antisociality may have a paradoxically facilitating effect on decision-making and cognitive impulsivity among SDIs.     

Unintentional drug overdose: Is more frequent use of non-prescribed buprenorphine associated with lower risk of overdose?

BackgroundUnintentional drug overdoses have reached epidemic levels in the U.S. This study tests the hypothesis that people who have used non-prescribed buprenorphine more frequently in the past six months were less likely to experience a drug overdose during that same time period.MethodsParticipants age 18 years or older with opioid use disorder who reported use of non-prescribed buprenorphine in the last six months were recruited from the Dayton, Ohio, area using a combination of targeted and modified respondent-driven sampling. Participants completed a structured interview, including six-month timeline follow-back, after informed consent. Logistic regression was used to test the association between (log-transformed) frequency of non-prescribed buprenorphine use and overdose in the previous six months, adjusted for confounding due to sex, homelessness, incarceration, substance use treatment, previous overdose, heroin/fentanyl injection, psychiatric comorbidity, and (log-transformed) frequencies of other (non-opioid) drug use.ResultsAlmost 89% of 356 participants were white, 50.3% were male, and 78.1% had high school or greater education. Over 27% (n = 98) reported experiencing an overdose in the past six months. After adjusting for confounding, greater frequency of non-prescribed buprenorphine use was significantly associated with lower risk of overdose (AOR = 0.81, 95% CI = 0.66, 0.98; p = .0286). Experiencing an overdose more than six months ago (AOR = 2.19, 95% CI = 1.24, 3.97); injection as the most common route of administration of heroin/fentanyl (AOR = 2.49, 95% CI = 1.36, 4.71); and frequency of methamphetamine use (AOR = 1.13, 95% CI = 1.02, 1.27) were strongly associated with increased risk of recent overdose in multivariable analysis.DiscussionThe findings support our hypothesis that higher frequency of non-prescribed buprenorphine use is associated with lower risk of drug overdose, a potential harm reduction consequence of diversion. Improving the availability of buprenorphine though standard substance use disorder treatment, primary care, and other innovative methods is urgently needed.     

Are Hispana IDUs Tecatas?: reconsidering gender and culture in Hispana injection drug use

The roles of gender and culture remain elusive in the discussion of minority male vs. female Injecting Drug User (IDU) populations. A case in point is that of Hispano and Hispana IDUs. The commonly used street term for the Hispano (male) IDU, Tecato, is feminized through the use of the corresponding female noun Tecata. To do so however, minimizes the intricacies of gender and culture in the male vs. female roles of Hispano and Hispana IDUs (e.g., daughter/son, mother/father, partner, citizen). Hispano IDUs are also impacted by gender and culture in that Hispanos who embrace the Tecato way of life, must sacrifice and inure the consequences in how their male roles are minimized (e.g., the absent male figure in community, home, and family life). This article explores, through the analysis of qualitative interview data, the demands of gender and culture as they play themselves out in the lives of Hispana IDUs. Findings from this study suggest there are important gender and culture differences between Hispano and Hispana IDUs. Implications of this study include the need to reexamine the roles of gender and culture as they cause added pressure to Hispana IDUs (i.e., in demands to fulfill gender and culture stereotyped roles while also pursuing an IDU career).     

How do seniors respond to 100% cost-sharing for prescription drugs? Quality of the evidence underlying opinions about the Medicare Part D coverage gap

Popular press coverage of the Medicare Part D coverage gap is based largely on research conducted using retrospective analyses of administrative claims data. These datasets are incomplete because they lack information about methods of obtaining medication that are commonly used by seniors, including free samples, generic drug discount programs, over-the-counter substitution, and patient assistance programs. As a result, evidence about the effects of 100% cost sharing on seniors is limited and suboptimal. Although the current deficit of information about the coverage gap is not entirely unexpected because the Medicare Part D program is relatively new, reliance on claims-based analyses to inform questions that claims data cannot possibly address accurately has tended to mislead and politicize rather than produce constructive policy guidance. Numerous important health policy questions remain unaddressed. These questions are becoming especially important as optimal approaches to providing health care to seniors are the subject of an increasingly vigorous debate.     

Circumstances of initiation into new-type drug use among adults in Shanghai: Are there differences by types of first new-type drug used?

Background

This study investigated circumstances of initiating new-type drug use among adult new-type drug users and differences among those who first used methamphetamine, ecstasy and ketamine.

Methods

A total of 276 participants were recruited, using respondent-driven sampling (RDS) from nine seeds recruited through NGOs, social workers and outreach workers in Shanghai, China.

Results

Methamphetamine was the most frequently reported first new-type drug used (37.1%), followed by ecstasy (35.6%) and ketamine (20.0%). 38.7% of participants initiated new-type drug use before the age of 21 years. 47.8% knew at initiation that club drugs can be harmful. Most were introduced to new-type drug use by friends, spouses or boy/girlfriends. The three most common reasons for initiation were curiosity, peer influence, and wishing to dull one's emotions. Those first using methamphetamine were more likely to be female, have a monthly individual income less than 3000 Yuan (approx. $476), initiate use at 21 years or older and at private setting than those first using ecstasy and ketamine.

Conclusions

There is an urgent need for drug education efforts in China to raise awareness of the harms of new-type drugs, as well as to increase knowledge about the paradox of new-type drug effects. Drug prevention and intervention programs should be tailore to target populations and their social context.     

Do current smokers use more cigarettes and become more dependent on nicotine because of psychological distress after a natural disaster?

Natural disasters increase nicotine dependence and cigarette consumption, but the exact mechanisms and conditions responsible for this increase are relatively unclear. This study explored whether posttraumatic stress and depressive symptoms were pathways to increased nicotine dependence and cigarette consumption after disaster exposure using a representative sample of current smokers who were living in New Orleans at the time Hurricane Katrina struck (n = 175), and a comparison sample of smokers from Memphis (n = 222) who were not directly impacted by Hurricane Katrina. We assessed whether nicotine dependence and daily cigarette consumption differed by city and evaluated potential mediators and moderators of this association using conditional process analysis. Results showed that though nicotine dependence (B = 0.46, SE = 0.20, p = .02) and average daily cigarette consumption (B = 2.19, SE = 0.80, p = .01) were higher among New Orleans than Memphis smokers 27 months after Hurricane Katrina, hurricane exposure did not indirectly affect nicotine dependence and average daily cigarette consumption through increases in posttraumatic stress and depressive symptoms. Smokers who are exposed to disasters may not be increasing their cigarette use and their dependency on nicotine because of post-disaster psychological distress. Future studies should investigate other mechanisms and conditions to explain post-disaster changes in smoking behavior.     

The dopamine D3 receptor and drug dependence: effects on reward or beyond?

Abused drugs (alcohol, heroin, cocaine, tetrahydrocannabinol and nicotine) elicit a variety of chronically relapsing disorders by interacting with brain reward systems. All of these drugs increase dopamine levels in the shell of nucleus accumbens, a structure that has been involved in their hedonic and reinforcing properties. Dopamine D(3) receptors (DRD3) are predominantly expressed in the nucleus accumbens, but also in the ventral tegmental area and in the amygdala, brain structures implicated in drug dependence. Moreover, converging pharmacological, human post-mortem and genetic studies have suggested the involvement of the DRD3 in drug dependence. Based on early studies using non-selective DRD3 ligands, the DRD3 was proposed as having a direct role in the rewarding effects of psychostimulants. However, recent studies using highly selective DRD3 ligands and the DRD3-deficient mice have revealed that the DRD3 is not implicated in the direct reinforcing effects of drugs of abuse. In contrast, the DRD3 appears to be implicated in the motivation to self-administer drugs under schedules where the response requirements are high. This is consistent with a behavioral economic analysis, with the effects of DRD3 ligands revealed only in situations with high prices for drug. Drug-self administration and relapse are strongly controlled by environmental stimuli. The DRD3 strongly modulates the influence of these environmental stimuli on drug-seeking behavior. DRD3 blockade disrupts the reactivity to drug-associated stimuli in various paradigms, such as second-order schedules of drug-self administration, conditioned place preference and Pavlovian conditioning procedures. In several paradigms, the involvement of the DRD3 has been confirmed by using DRD3-deficient mice. On the contrary, reactivity to stimuli associated with natural reinforcers, such as food, appears unaffected by modulation of the DRD3. All these findings suggest that DRD3 ligands may represent a useful strategy for decreasing relapse in abstinent drug-abusers.     

Adverse drug reactions associated with the use of liraglutide in patients with type 2 diabetes – focus on pancreatitis and pancreas cancer

Introduction: The glucagon-like peptide-1 (GLP-1) receptor agonist, liraglutide, is a widely used drug for the treatment of type 2 diabetes. Liraglutide is one of several incretin-based agents that have been suggested to be associated with pancreatitis and pancreas cancer. The suspicion accelerated after publication of an autopsy study claiming increased incidences of several pathological changes in pancreata from patients with diabetes treated with incretin-based drugs.

Areas covered: The aim of the present review is to give an overview of the pharmacology of liraglutide and provide a review of adverse reactions associated with liraglutide with a focus on the risk of pancreatitis and pancreas cancer.

Expert opinion: When comprehensively reviewing the available literature, no clear and significant associations between liraglutide and pancreatitis and/or pancreas cancer seem evident. However, a recently published analysis suggests a trend toward a slightly elevated risk of pancreatitis with GLP-1 receptor agonists (including liraglutide), which may become statistical significant as more data become available. Well-established side effects are of gastrointestinal origin, typical mild-to-moderate and of transient character. The risk of hypoglycemia associated with liraglutide treatment is low.     

Are educational aspirations associated with the risk of alcohol use and alcohol use-related problems among adolescents?

OBJECTIVE: Using prospective data, we hypothesized that public middle school students with high educational aspirations would report less alcohol use, and alcohol use-related problems in the subsequent year. METHODS: The participants for these analyses included students, ages 11 to 14 years old, participating in a longitudinal study in an urban sample of public schools (n = 1229). As part of the prospective annual assessments of the students, in 1992 (to) and 1993 (t1), data on educational aspirations and on alcohol use, and alcohol use-related problems were gathered. Latent variable modeling was used to assess the relationship between educational aspirations at baseline (to) and subsequent year drinking behavior (t1) in two separate models, one to examine the relationship of educational aspirations with self-reported alcohol use (model 1), and another to examine the association with alcohol use-related problems (model 2). Potential confounding by age, sex, race-ethnicity, alcohol use by peers, self-reported school performance, and neighborhood environment was held constant in each model. In addition, each model took into account the prior year report of alcohol use and alcohol use-related problems, respectively. RESULTS: The evidence indicated that students with high aspirations were no more nor less likely to report subsequent alcohol use [beta = 0.15, 95% confidence interval (CI) = -0.19, 0.49; p = 0.38] nor alcohol use-related problems (beta = -0.009, CI = -0.07, 0.06; p = 0.80). Other characteristics were associated with alcohol use at follow-up and included race-ethnicity (being non-Black), neighborhood environment, and having friends who drink alcohol. Characteristics associated with alcohol use-related problems at the time of the follow-up interview also included race-ethnicity, peer drinking, neighborhood environment, as well as older age. CONCLUSIONS: Findings from the current study do not support the hypothesis that educational aspirations have significant influences on alcohol consumption or drinking problems in this study population of urban, predominantly Black students. As such, this work helps to advance our understanding of suspected relationships between educational aspirations, as well as factors associated with resilience to alcohol use and the occurrence of alcohol use-related problems.     

Driving among drug users: Are we doing enough? A chart review of assessment of driving and related issues in drug misusers

Aim: Driving among drug users is a major health concern. Professionals working in substance misuse service have a duty of care to manage the risks involved. We analysed the practice of multidisciplinary team in drug treatment service discussing driving with the patient and providing them with relevant information regarding the regulations. We compared this practice with the existing policies and guidelines.

Method: A chart review of healthcare professionals in the drug treatment services discussing driving and related issues with the patient was carried out. One hundred case records were analysed for evidence of documentation of the above information.

Results: A clear record of discussion of all driving-related issues was documented in only 28% of records reviewed. In more that half of the cases there was no record as to whether the patient was driving or not.

Conclusions: The results raised some ethical questions that would influence the policy makers and practitioners. These finding suggest that major changes are needed in our practice both for our legal protection and for the best interests of patients and public.     

The role of alcohol use and cigarette smoking in sickness absence: Are there social inequalities?

BackgroundWhile studies have found a social gradient in negative consequences of drinking and smoking, evidence is less clear for a gradient also in alcohol use and smoking's association with sickness absence. We investigate the association between alcohol use and cigarette smoking and general sickness absence, and examine the moderating role of socio-economic status for these associations when controlling for general health status.MethodQuestions on alcohol use, measured by the Alcohol Use Disorders Identification Test (AUDIT-C), smoking, general health and sickness absence were included in annual national cross-sectional telephone surveys on alcohol, tobacco and drug use (2015–18) amongst Norwegian adults aged 16–79-years (average response rate=59%). The analytic sample comprised 4719 full- and part-time employees aged 25–79 years (46.7% were female, mean age=44.3 years). Individual-level data on education were obtained from national registries.ResultsIn adjusted negative binomial regression analyses, current and former daily smoking were associated with a higher occurrence of sickness absence in groups with low educational attainment, but not in groups with high educational attainment. Alcohol use was negatively associated with sickness absence. While a significantly higher number of sickness days was reported by smokers in the low compared with the high education group, educational attainment did not moderate the alcohol use – sickness absence association.ConclusionDaily smoking is associated with sickness absence. A negative social gradient was found in the smoking – absence association. Reduced daily smoking might give a reduction in sickness absence.     

Media resistance skills and drug skill refusal techniques: What is their relationship with alcohol use among inner-city adolescents?

Past research related to alcohol advertising examined whether underage adolescents were targets of the alcohol industry and what impact such advertising had on adolescent drinking. The purpose of this study was to longitudinally examine the impact of media resistance skills on subsequent drinking among adolescents residing in inner-city regions of New York City. The study also tested whether drug skill refusal techniques (knowing how to say no to alcohol and other drugs) mediated the relationship between media resistance skills and adolescent drinking. A panel sample of baseline, one-year and two-year follow-ups (N=1318) from the control group of a longitudinal drug abuse prevention trial participated. A series of structural equations models showed that media resistance skills directly negatively predicted alcohol use 2 years later and that drug skill refusal techniques mediated this effect. Baseline media resistance skills were associated with one-year drug skill refusal techniques, which in turn negatively predicted two-year alcohol use. These findings provided empirical support for including media resistance skills and drug skill refusal techniques in alcohol prevention programs.