Which psychoactive substances are used by patients seen in the healthcare system in French overseas territories? Results of the OPPIDUM survey

Addiction to illicit substances or medicines is influenced by cultural, religious, ethnic factors as well as local availability. The purpose of this study was to evaluate the profile of drug users and characteristics of the psychoactive substances used in French overseas territories, using data from the OPPIDUM survey. OPPIDUM is an annual, nationwide, multicentric, cross‐sectional study based on specialized care centres that included subjects presenting a drug addiction or under opiate maintenance treatment. The current study includes data from the 2012 and 2013 surveys and focuses on patients included by drug addiction centres located in French overseas departments and territories: French Pacific Ocean (French Polynesia, New Caledonia), French Americas (Guadeloupe, Saint Martin, French Guiana) and Reunion Island. Data from metropolitan France (2013 survey) were included as reference. Two hundred and forty‐five patients were included. The sex ratio was 3.7 for the Pacific Ocean, 3.5 for the French Americas and 3.3 for Reunion Island. Cannabis was consumed in all the territories, from 50.8% in Reunion Island to 81.7% in Pacific Ocean. Cocaine was most frequently consumed in the French Americas (61%), mainly in the ‘freebase’ form (91%), whereas 6.5% of cocaine users in metropolitan France did so. Problematic use of medicines was most frequent in Reunion Island. Heroin seems rarely used in all overseas territories. This study highlights the complexity of substances used in French overseas territories, which often differ from that in mainland France. The relative difference between different areas provides valuable information for future investigations and possible interventions.     

From the internet to the hospital: current experiences of individuals presenting to the Emergency Department with acute recreational drug toxicity

Background: Acute recreational drug toxicity is a common cause of emergency department (ED) presentations. There is limited published information on the perception, knowledge and experiences of these patients with regards to seeking medical care.

Methods: Thirty-one participants with acute recreational drug toxicity completed a two-page questionnaire survey to gather information on previous health services used in relation to drug use, knowledge of sources of information on drugs, how their admission may influence their future use of drugs and their experience with their current hospital stay.

Results: This was the first presentation to hospital with acute recreational drug toxicity in 20 (62.5% of respondents) participants. For 19 (59.4%), this admission would lead to stopping or reducing the use of recreational drugs/noel psychoactive substances (NPS). Seventeen (53.1%) of them utilised the Internet as a source of information on recreational drugs. Mean satisfaction score in relation to current attendance of 84.8 (range 46–100) and 29 (91%) would return to this hospital for treatment for future recreational drug problems.

Conclusion: Contact with healthcare staff in an emergency setting may be the only access to healthcare services; it is important that this opportunity is utilised to inform individuals about the harms associated with using recreational drugs/NPS and sources of help/advice if required.     

Resourcing the clinical complementary medicine information needs of Australian medical students: Results of a grounded theory study

The aim of this study was to identify Australian medical students’ complementary medicine information needs. Thirty medical students from 10 medical education faculties across Australian universities were recruited. Data were generated using in‐depth semi‐structured interviews and constructivist grounded theory method was used to analyze and construct data. Students sought complementary medicine information from a range of inadequate sources, such as pharmacological texts, Internet searches, peer‐reviewed medical journals, and drug databases. The students identified that many complementary medicine resources may not be regarded as objective, reliable, differentiated, or comprehensive, leaving much that medical education needs to address. Most students sought succinct, easily accessible, evidence‐based information to inform safe and appropriate clinical decisions about complementary medicines. A number of preferred resources were identified that can be recommended and actively promoted to medical students. Therefore, specific, evidence‐based complementary medicine databases and secondary resources should be subscribed and recommended to medical schools and students, to assist meeting professional responsibilities regarding complementary medicines. These findings may help inform the development of appropriate medical information resources regarding complementary medicines.     

Evaluation of internet websites marketing herbal weight-loss supplements to consumers

OBJECTIVE: The aim of this study was to evaluate the quality and quantity of drug information available to consumers on Internet websites marketing herbal weight-loss dietary supplements in the United States. METHODS: We conducted an Internet search using the search engines Yahoo and Google and the keywords "herbal weight loss." Website content was evaluated for the presence of active/inactive ingredient names and strengths and other Food and Drug Administration (FDA) labeling requirements. Information related to drug safety for the most common herbal ingredients in the products evaluated was compared against standard herbal drug information references. RESULTS: Thirty-two (32) websites were evaluated for labeling requirements and safety information. All sites listed an FDA disclaimer statement and most sites (84.4%) listed active ingredients, although few listed strengths or inactive ingredients. Based on the drug information for the most common ingredients found in the weight-loss dietary supplements evaluated, potential contraindications for cardiovascular conditions, pregnancy/nursing, and high blood pressure were listed most frequently (73%, 65.5%, and 37%, respectively), whereas few websites listed potential drug interactions or adverse reactions. CONCLUSIONS: Potential hazards posed by dietary supplements may not be accurately, if at all, represented on Internet websites selling these products. Since consumers may not approach their physicians or pharmacists for information regarding use of dietary supplements in weight loss, it becomes necessary for health care providers to actively engage their patients in open discussion regarding the use, benefits, and hazards of dietary supplements.     

Self-epistemic authority and nurses' reactions to medical information that is retrieved from Internet sites of different credibility

This cross-sectional study investigated nurses' reactions to Internet medical information that was retrieved from sources of different scientific credibility and the association between self-epistemic authority and these reactions. The participants filled in questionnaires on their reactions to Internet medical information and self-epistemic authority. The nurses' reactions to Internet medical information from a highly credible source (Medline) correlated positively with self-epistemic authority. However, no such correlation was found with Internet medical information from a less credible Internet source (Ynet). Compared with the nurses without an academic degree, the nurses with an academic degree had more positive reactions to the information that was retrieved from Medline. The reactions to the medical information that was retrieved from Ynet did not differ by the education of the nurses. This study shows that nurses' reactions to different sources of Internet information vary according to their level of self-epistemic authority and education. As patients' use of Internet medical information is increasing, nurses need to expand their expertise in the various professional and popular medical information sites. Such skills will help to reduce any negative feeling that might arise when they encounter patients who present medical information from the Internet.     

Ask the pharmacist: an analysis of online drug information services

BACKGROUND: The Internet plays a large role in the provision of drug information. Given the growing number of patients seeking consultation on the Internet and the difficulty in regulating online pharmacy providers, an analysis of drug information provided by Internet pharmacies is warranted. OBJECTIVE: To assess the response rates and quality of responses to drug information questions submitted to "ask the pharmacist"services on Internet pharmacy sites and determine whether differences exist between National Association of Boards of Pharmacy-approved and nonapproved sites and among free-standing, chain, and independent pharmacy sites in the quality of information provided. METHODS: A content analysis was conducted on responses to 5 drug information questions electronically mailed to each of 64 Internet pharmacies identified through a meta-engine search. Three judges rated the quality of response components using a scoring system developed by an expert panel, with inter-rater reliabilities subsequently calculated. Both t-test and ANOVA procedures tested for differences in response quality. RESULTS: Responses were received for 51% of all questions submitted to the sites. Few differences in quality were found between approved/unapproved sites and among types of pharmacies. The percentage of correct responses provided for each of 22 response components ranged from 7% to 96%. CONCLUSIONS: While few differences were found among sites based on their approval status or type, low response rates and incomplete counseling information among many of the responses are cause for concern.     

Misuse of drugs in recreational sports

The extent of drug abuse in mass sport is only poorly documented. Studies about drug abuse investigated only the prohibited substances according to the Olympic movement antidoping code. So for instance about the use of anabolic androgenic steroids (AAS) by school children or young students. But only few investigations point to the drug abuse in mass sport regarding the easily accessible over-the-counter drugs of the class of nonsteroidal anti-inflammatory drugs (NSAID). These drugs permit an athlete to compete at his normal level of performance despite injuries or pain. However, the masking of pain may exacerbate the injury. Precautions should be taken to prevent the unwarranted or unmonitored use of anti-inflammatory agents during treatment of sport injuries. The abuse may be extensive since most people consider over-the-counter drugs, such as aspirin and ibuprofen, harmless. Studies in Switzerland among endurance athletes in mass sport examining the use of medications before an event showed a prevalence between 5 and 10% of NSAID. Even if this seems a small number, further investigations should focus on the use of medications among different age groups and preventive information to abstain from the use of certain medication for competitors in mass sport should be worked out.     

An open trial of self‐help behaviours of clients with eating disorders in an online programme

Aim. The aim of this study was to evaluate the self‐help behaviour of individuals with eating disorders in an Internet‐based self‐help programme developed in the Asia‐Pacific region and to determine their compliance with the programme. Background. Eating disorders represent a growing health problem affecting both Western and Asian countries. Without timely and adequate treatment, individuals with eating disorders are at risk of premature death. Self‐help approaches for treating eating disorders offer therapeutic promise. Design. An open trial design was used. Method. This study, conducted from August 2006–July 2011, included 280 participants recruited from outpatient eating disorder clinics and treatment units and through a university student newspaper and Internet websites. This open trial evaluated an Internet‐based self‐help programme, which included components on healthy eating, family education, health assessment, motivation enhancement, self‐help strategies, and psychological health promotion. The progress of participants was followed up via monthly e‐mails. A tracking system was implemented to determine their compliance with the programme. Findings. A small majority of the participants (56·9%) were already undergoing treatment for their eating disorders. About 63% (n = 176) demonstrated self‐help behaviour, as manifested by their completion of health assessment questionnaires, involvement in motivation enhancement exercises, or the use of self‐help strategies such as monitoring, normalizing eating behaviour, and stress management. Improvements were observed in their eating disorder psychopathology, motivational stage of change and psychological health from baseline to the 1‐month follow up. Conclusion. Internet‐based self‐help programmes for eating disorders are helpful adjuncts to professional treatment.     

Implication of Internet growth on enhancing health of disadvantaged groups in China: a global perspective

The Internet is promising to play a prominent role in health care in the future, but there is an imbalance in its use between the East and the West, between genders, the rich and poor, the educated and uneducated and the urban and rural. This paper looks at the use of the Internet from the perspective of these subgroups across the world, and outlines some of the problems facing disadvantaged groups in particular older people and their caregivers in China. Older people and their predominantly family caregivers have limited access to computers which is compounded by lack of access to good health care. However, it is suggested that this will become a growth area as older people and their caregivers may well bypass traditional care for telehealth care and Internet information‐based systems.     

Pharm-ing cyberspace: the Internet as a tool for evidence based pharmacotherapy

Although the Internet lacks many of the features of a desirable drug information system, it has increasing potential to inform evidence-based patient management. This article considers three contributions that the Internet can make to evidence-based pharmacotherapy; as a delivery mechanism for textual documents, as a complementary source of intelligence and as a source of value-added information. Focusing on exemplar sites, rather than on drug and information sources in general, the author reviews the usefulness and availability of current resources. While limitations of the technology presently constrain its use for direct patient care and the quality of any information must be critically appraised, the Internet has already proved a valuable source for drug evaluation, education, research and audit.     

New drugs of abuse in North America

The term "drugs of abuse" usually brings to mind traditional street drugs, such as cocaine, heroin, marijuana, and methamphetamine.The drug scene, however, is constantly evolving. As various law enforcement agencies pursue and dismantle distribution and pro-duction organizations of the usual drugs of abuse, dealers and users are turning to less known, more accessible, and often currently licit substances. The widespread growth of the Internet with its vast distribution of information has increased the accessibility ofa host of substances and facilitated synthesis and production of various substances by individuals. This article discusses several new and emerging abused substances, including new synthetic variations, plants, and pharmaceuticals diverted for abuse.     

Evaluating the effects of an Internet education programme on newborn care in Taiwan

Aim. The objectives of this study were to evaluate an Internet education programme provided to primigravida in the third trimester of pregnancy with the aim of enhancing mothers’ knowledge about newborn care and increasing their maternal confidence. Background. Shorter hospital stays have had an impact on the traditional role of mother–baby nurses in providing education about parenting to their parturient women. Internet education is an efficient way to provide nursing instruction. Design. A randomised controlled trial was used. A total of 118 women receiving prenatal care in a hospital clinic who met study criteria and who consented were assigned randomly to intervention and control groups. The study was conducted at a hospital in Taiwan. Methods. The target population was women at 32–34 weeks gestation, using the Internet on a regular basis. The primigravida were randomly assigned to either the control group (n = 57) or the experimental group (n = 61). Two primary outcome measures were newborn‐care knowledge and maternal confidence. Results. The changes in newborn‐care knowledge were 7·21 for the experimental group, compared with 1·95 for the control group; the difference between the least‐squares means computed by ancova was 5·73 and statistically significant (p < 0·001). The changes in maternal confidence were 8·46 for the experimental group and 3·05 for the control group; the difference between the least‐squares means computed by ancova was 5·94 and statistically significant (p < 0·001). Conclusion. Results suggest that Internet education about newborn care may contribute to greater care knowledge and maternal confidence. Relevance to clinical practice. Internet newborn‐care education programmes can achieve success in promoting newborn care and provide health professionals with evidence‐based intervention.     

E‐selectin targeting to visualize tumorsin vivo

Generally angiogenic factors induce the expression of E‐selectin in vascular endothelial cells in the tumors. In this study, we employed an anti‐E‐selectin monoclonal antibody to target tumors in vivo and evaluated an optical imaging reagent to visualize tumor regions. The anti‐E‐selectin antibody was conjugated on the surface of liposomes, which encapsulated the near‐infrared fluorescent substances Cy3 or Cy5.5. The liposomes efficiently recognized human umbilical vein endothelial cells only when E‐selectin was induced by angiogenic factors such as TNF‐α in vitro. Cy5.5 encapsulated into liposomes that were conjugated with an anti‐E‐selectin antibody successfully visualized Ehrlich ascites tumor cells when transplanted into mice. Thus, E‐selectin targeting with liposomes containing a near‐infrared fluorescent dye was found effective in visualizing tumors in vivo. This strategy should be extremely useful as a method to identify sentinel lymphatic nodes and angiogenic tumors as well as use for drug delivery to tumor cells. Copyright © 2010 John Wiley & Sons, Ltd.     

Identification of novel psychoactive drug use in Sweden based on laboratory analysis – initial experiences from the STRIDA project

Abstract

Aim. The study aimed to collect information concerning the increasing use of new psychoactive substances, commonly sold through online shops as ‘Internet drugs’ or ‘legal highs’, or in terms of masked products such as ‘bath salts’ and ‘plant food’. Methods. The Karolinska Institutet and Karolinska University Laboratory and the Swedish Poisons Information Centre have initiated a project called ‘STRIDA’ aiming to monitor the occurrence and trends of new psychoactive substances in Sweden, and collect information about their clinical symptoms, toxicity and associated health risks. A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) multi-component method has been developed, currently allowing for the determination of > 80 novel psychoactive compounds or metabolites thereof. This study focused mainly on the particular drug substances identified and the population demographics of the initial STRIDA cases. Results. In urine and/or blood samples obtained from 103 consecutive cases of admitted or suspected recreational drug intoxications in mostly young subjects (78% were ≤ 25 years, and 81% were males) presenting at emergency departments all over the country, psychoactive substances were detected in 82%. The substances comprised synthetic cannabinoids (‘Spice’; JWH analogues), substituted cathinones (‘bath salts’; e.g. butylone, MDPV and methylone) and tryptamines (4-HO-MET), plant-based substances (mitragynine and psilocin), as well as conventional drugs-of-abuse. In 44% of the cases, more than one new psychoactive substance, or a mixture of new and/or conventional drugs were detected. Conclusion. The initial results of the STRIDA project have documented use of a broad variety of new psychoactive substances among mainly young people all over Sweden.     

Enhancing motivation to change in eating disorders with an online self‐help program

Ambivalence to change is a major obstacle to treating people with eating disorders. Enhancing motivation to change can contribute to recovery from the disorders. This study used an Internet‐based self‐help program developed in the Asia–Pacific region to identify the motivational stages of change in people with eating disorders. It explored their perceptions of the benefits and costs of taking action against their eating disorders, and assessed their involvement in motivational enhancement exercises and their improvement in eating disorder psychopathology. A total of 185 participants, aged 16–50 years (mean age, 26.5) were involved in the open‐trial program with a motivational enhancement component and completed the Motivational Stages of Change Questionnaire (MSCARED), the Eating Disorder Examination Questionnaire version 5 (EDE‐Q5) and the Eating Disorder Inventory version 3 (EDI‐3). The results show that more participants perceived the benefits of taking action against their eating disorders than the costs. Completer analysis shows that they experienced significant improvement in motivational stages of change and eating disorder psychopathology, from a baseline assessment to 1‐month and 3‐month follow ups. The self‐help program has potential benefit for people with eating disorders and its use could be encouraged by health‐care professionals to enhance the motivation to change and facilitate recovery.     

Resources,Staff Beliefs and Organizational Culture: Factors in the Use of Information and Communication Technology for Adults with Intellectual Disabilities

Background Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First‐order (e.g. time and money) and second‐order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT‐related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results Staff members reported time, training and budget as significant first‐order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second‐order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first‐ and second‐order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.     

Many employees reluctant to use Internet for health information

While many people may use the Internet to research buying a new car or planning a vacation, they may be less likely to use it for obtaining information on a medical condition. Those who do use the Internet to gather health information are more likely to be white, well-educated, and higher-paid.     

Aspects of control and substance use among middle‐aged and older adults with bipolar disorder

High prevalence rates of alcohol and substance use disorders have been reported among persons with bipolar disorder (BD). In the present study, we explored the daily experiences of middle‐aged and older adults living with BD who reported regular substance use and the ways in which participants expressed ‘control’ in relation to their use of alcohol and other substances. Semistructured, in‐depth interviews were conducted with 12 participants (nine women and three men), aged 36–57 years of age (mean = 49 years). Thematic analyses identified emergent themes and patterns in participants’ life histories. The theme of ‘control’ emerged as central to participants’ reports, and was organized into four categories: (i) substance use to control BD symptoms; (ii) substance use provides a sense of being in control; (iii) methods of controlled substance use; and (iv) not having control: overreliance on substances. Implications of the present study include the need for nurses to openly discuss the use of alcohol and other drugs with persons with BD, provide health information and screening, and determine whether persons with BD feel they have control over their substance use. Several lines of research with persons who have BD and use substances are suggested.